5.3 Increased Intracranial Pressure (ICP) and Diagnostic Flashcards Preview

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Flashcards in 5.3 Increased Intracranial Pressure (ICP) and Diagnostic Deck (7)
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1
Q

Increased ICP Early Signs

A

3 Components enclosed in the skull (brain, blood, cerebrospinal fluid) - Change in these components causes change in other’s due to compensation.

Infants
- HALLMARK SIGN - High-pitched cry (neurocry)
- Macewen’s (cracked-pot) sign - Brain, sutures, fontanels swell and bulge (can easily see suture lines and vasculature of skull)
- Setting Sun Sign - Eyes tilted downward due to pressure in brain pushing eyes
- Headache/Vomiting/Fatigue/Irritability

Older Children
- Extreme headaches (most common symptom) on awakening after lying flat

2
Q

ICP Late Signs

A

Changes in Vital Signs (Cushing’s Triad)
- Increase in systolic pressure but decrease in pulse/pressure. OPPOSITE OF SHOCK
- Bradycardia
- Cheyne Strokes Respirations
- Widened pulse pressure

Other Signs
- Papilledema (optic nerve swelling)
- Decreased consciousness (COMA)
- Lack of response to painful stimuli

3
Q

ICP Nursing Interventions

A
  • Elevate HOB to 15-30 degrees to facilitate venous drainage
  • Maintain head at midline (straight and not tilted) to avoid jugular compression
    (Use firm foam or sand bags)
  • Turn every 2 hours to reduce pooling of secretions
  • Foley catheter (especially when giving mannitol which decreases pressure in skull)
  • Maintain hydration and nutrition (especially in COMA)
4
Q

Posture of Neurological Conditions

A

Decorticate
- Flexor (arms move inward like c)
- Issues with spinal tract or cerebral hemisphere

Decerebrate
- Extensor (arms move outward like e)
- Problems with midbrain or pons

5
Q

Diagnostics for Neurological Conditions

A
  • Health History
  • Physical Assessment to see clinical presentation
  • CT/MRI to see brain abnormalities

Labs
- CBC
- Blood cultures (check for sepsis/infection)
- Electrolyte balance
- Clotting factors

  • Lumbar Puncture (most common diagnostic tool to learn what is housed in the CSF - cerebrospinal fluid)
  • Needle is inserted into L3-L4 or L4-L5 into subarachnoid space to drain some CSF
  • Checking for RBC, WBC, glucose, protein, cultures.
  • The process for this is similar to an epidural where it is drained from the lower back spine. Usually baby is curled forward.
  • Important to note pain management for these lumbar punctures (use numbing creams like lidocaine or pre-medicate patients with Tylenol or sugar water)
  • Patient can be sitting up or side lying but the back needs to be rounded.
  • After collecting CSF, make sure you provide adequate pressure to puncture site to avoid CSF leakage. Patients should lie flat for 4-8 hours while you monitor for bleeding or infections.
  • Infections are important to watch because there is a direct tract to spinal tract and brain.
  • Leakage of CSF can lead to spinal headache.
6
Q

Late Signs of ICP

A
  • Papilledema
  • Respiratory Distress
  • Deteriorating LOC
  • Fixed Pupils
  • Dilated Pupils
7
Q

ICP

A
  • Manifests differently in pediatrics because open sutures can somewhat compensate for increased pressure

Symptoms
- Increased skull size, bulging fontanelles, extension of cranial veins, loss of memory/attention and nausea

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